We read with interest the College's report OP95,1 prompted by concerns over a lack of supervised trainee exposure to emergency psychiatric presentations, particularly out of hours. We carried out a retrospective study into the demands psychiatric presentations pose on both the liaison psychiatry service and the emergency department. The aim was to determine whether the liaison psychiatry service met the demand for out-of-hours presentations.

The study examined a total of 116 presentations over 2 months and covered 81 patients (46% of whom re-presented at least once). The patients were between 15 and 68 years old; 54% were female and 46% were male. Self-harm was the most common cause for presentation (53%), followed by suicidal ideation (37%). Other complaints included hallucinations, anxiety and ‘strange behaviour’, with some patients presenting with a combination of the above. Of these presentations, 89 (77%) occurred out of hours, most commonly on Sunday. Interestingly, although there was an overall higher presentation rate overnight, the peak presentation time frame was between 14:00 h and 14:59 h.

Out of the 55 referrals to psychiatry services, 40 (72%) were made out of hours, meaning the day liaison psychiatry team received only 9 documented referrals. Since the vast majority of psychiatric presentations and psychiatry referrals from the general hospital emergency department occur out of hours, this reinforces the importance of trainees gaining adequate out-of-hours experience to learn to manage these complex patients safely. Increased exposure would allow trainees to develop competence in managing such complex situations and also develop the necessary expertise to supervise others. Of course, we must also acknowledge that this idea creates a catch-22 situation: an increase in junior trainee input would naturally create an increased demand for senior doctors to take up out-of-hours supervisory roles. The impact of this on 9 to 5 working, banding and recruitment could be considerable, and would require consultation and agreement from senior doctors.